Anterior uveitis Flashcards
What is anterior uveitis/iritis?
Inflammation of the anterior part of the uvea.
Anterior chamber of the eye becomes infiltrated with neutrophils leucocytes and macrophages.
What makes the uvea?
Iris, ciliary body and the choroid.
What is the choroid?
The layer between the retina and sclera all the way around the eye.
What are the causes of anterior uveitis?
Autoimmune (usually)
Infection
Trauma
Ischaemia
Malignancy
Clinical presentation of anterior uveitis?
Unilateral symptoms starting spontaneously.
Floaters
Dull aching red eye
Ciliary flush (redness from cornea outwards)
Reduced visual acuity
Miosis
Photophobia
Pain on eye movement
Excessive tear production
Abnormally shaped pupil due to posterior synechiae.
Associated flare of autoimmune disease.
Pathophysiology of chronic anterior uveitis?
Chronic - more macrophages. Less severe and longer duration of symptoms lasting more than 3 months.
Associated with granulomatous type conditions
e.g. Sarcoidosis, TB, Syphillis and Herpes.
What markers are associated with anterior uveitis?
HLA-B27 positive conditions.
Ankylosing spondylitis
Inflammatory bowel disease
Reactive arthritis
Management of anterior uveitis?
Referred for same day assessment by ophthalmologist as sight threatening cause of red eye.
Full slit lamp assessment.
Managed by specialist with steroids, cycloplegia mydriatic medications (e.g. Cyclopentolate and atropine drops - antimuscarinic drops that will block action of sphincter muscles and ciliary body)
DMARD’s/TNF inhibitors.
Surgical intervention.
What is episcleritis?
Benign self limiting condition causing inflammation of the episclera.
Clinical presentation of episcleritis?
Common in middle aged adults
Acute onset unilateral symptoms. mild discomfort/pain Segmental redness - usually lateral sclera. Foreign body sensation Eye watering
NO DISCHARGE.
Anatomical location of the episclera?
Directly underneath the conjunctiva
What is episcleritis associated with?
Inflammatory disorders such as RA and inflammatory bowel disease.
Management of episcleritis?
Refer to ophthalmology if diagnostic doubt.
Self limiting condition with full recovery in 1-4 weeks.
Conservative: lubricating eyedrops, analgesia, cold compresses and safety netting advice.
If severe, may benefit from Naproxen or topical steroid eyedrops under the guidance of specialist.
What is scleritis?
Inflammation of the full thickness of sclera. More serious than episcleritis.
What is the most serious type of scleritis?
Necrotising scleritis - have reduced visual acuity but no pain
May lead to perforation of the sclera.
associated conditions to scleritis?
Associated condition in 50% patients.
RA SLE IBD Sarcoidosis Granulomatosis with polyangitis.
Clinical presentation of scleritis?
50:50 bilateral unilateral acute onset usually Red dilated vessels underneath sclera - not movable with a cotton wool bud. Pain on eye movement Eye watering Reduced visual acuity Photophobia Abnormal pupil reactions to light Tenderness on palpation of the eye
Management of scleritis?
Same day referral to ophthalmologist
Management of underlying condition
Topical NSAID’s
Steroids - topical or systemic
What are corneal abrasions?
Scratches or damage to the cornea leading to red painful eye.
Common causes of corneal abrasions?
Contact lenses - associated pseudomonas underlying infection is common.
Finger nails
Eyelashes
Entropion
Important underlying infections to consider in patients with corneal abrasions?
Herpes simplex virus - treated with antiviral eyedrops
Pseudomonas infection in patients with contact lens associated abrasions.
Clinical presentation of corneal abrasion?
History of contact lens use or foreign body
watering eye
blurred vision
red eye
photophobia
Diagnosis of corneal abrasion?
Fluorescein stain - collects indents in eye from abrasions or ulcers.
Slit lamp examination to diagnose more significant abrasions
Management of corneal abrasions?
Simple analgesia (paracetamol)
Lubricating eyedrops
Antibiotic eyedrops as treatment/prophylactic
Review in one week
Cyclopentolate eyedrops aid in photophobia - not always necessary
